§ 79. Typhus putridus, febris putrida. Fever with decomposition of the animal matter.

Typhus putridus sometimes sets in as an epidemic fever; in which case it becomes a primary disease which is engendered by a putrid contagium; most frequently, however, typhus putridus developes itself out of an acute fever, and more particularly out of typhus; it may likewise arise from every other kind of fever, even from an inflammatory, by the patient being kept too hot, or in uncleanliness, vitiated air, etc. In men who are affected with some morbid dyscrasia, the scorbutic diathesis, or who have been poisoned with Mercury.

The fundamental character of typhus putridus is an excessive depression of the vital forces with disposition to putrid decomposition. Without mentioning again the general characteristic symptoms of typhus, which are the same in all the varieties of that disease, we will content ourselves with simply mentioning those which belong to typhus putridus exclusively; they are: quick, small, soft, easily compressible pulse; calor mordax, the hand, when touching the patient, experiences a disagreeable, pungent, burning, prickling and stinging sensation, which increases as the contact is prolonged and leaves a similar sensation behind for some time; internal chilliness occasionally, or shiverings creeping over the skin; the breathing is generally calm, no thirst; great anguish, despondency, indifference, insensibility. Characteristic indications are, likewise: putrid, cadaverous smell of the breath, of the exhalations from the skin, and of other secretions; petechia;; profuse, oily, clammy sweats; turbid, dark urine, colliquative diarrhoea, hemorrhages from every orifice of the body, decubitus, tendency to gangrene; the blood which is evacuated does not decompose itself into cruor and serum like healthy blood, but forms a pappy mixture.

§ 80. The treatment of these fevers, whether primary or consecutive diseases, is very seldom successful. The existing symptoms do not so much point to certain remedies as to a decomposition of the fluids and more particularly the blood.

The fever is not a putrid typhus, as long as symptoms of decomposition have not made their appearance. Even if the putrid state should set in as a primary disease, there are precursory symptoms denoting a gastric, bilious, pituitous, or typhoid state, and requiring a treatment such as has been indicated for those conditions.

The following remedies are principally indicated for that variety of typhus: Arsenicum, Arnica, Carbo veg. and anim.; Kreosot, Acidum phosp. and muriat.; China, Ipec, Mercur., Mercur. dulcis, Rhus, Bellad., Nux vom. and moschata, Hyose, Opium, and sometimes perhaps Camphor and Cuprum.

Arsenic is probably preferable to every other remedy when the disease has reached its worst stage, when the patient complains of burning heat, great anguish and restlessness, when petechia?, aphthae and profuse colliquative secretions are present. Arnica may be of use when profuse and frequent hemorrhages take place, and great thirst, headache, yellow countenance and loss of appetite are present. The two varieties of Carbo ought to be tried when the blood is entirely decomposed, when stupor and raling are present, with cold sweat of the face and limbs, hippocratic countenance, small, scarcely perceptible pulse, great distention of the veins, and especially, if such a fever occur after the excessive use of China. Kreosot may be of service when the patient complains of an excessive debility in the limbs, and when a racking, painful cough from the inmost parts of the chest is present, accompanied with a sensation of warmth which rises into the throat; and lastly, when the patient complains of a painful pressure on the top of the head which is aggravated by contact. The two acids correspond particularly to the colliquative stage. China is indicated at the commencement of the disease by hemorrhages, yellow skin and countenance, excessive, debility and pain in the limbs. Ipec. and Hyosc, may likewise be indicated at the commencement of the disease when the symptoms which have been described last, are accompanied by spasms. Rhus and Belladonna are preferable to all other remedies when the nervous system is principally involved in typhus putridus. Opium should be employed when the irritability of the organs is entirely gone, provided the other symptoms correspond. Nux is the remedy when the disease sets in with excessive debility and the gastric and bilious symptoms such as: livid complexion, bitter and putrid eructations and taste, yellow coating of the tongue, constipation, are predominant. Nux moschata is more particularly indicated when putrid debilitating diarrhoea and bloody expectoration are present. Mercurius is to be administered when the nervous system is very much excited, when there is a tendency to profuse sweats and putrid decomposition, accompanied with great painfulness of the region of the liver, the epigastrium, and pit of the stomach. Mercurius dulcis is indicated by similar symptoms, when the process of decomposition has reached its acme. We have no other reason for recommending Camphor and Cuprum except that these two remedies have been employed with success in Cholera, from which we have, perhaps wrongly, inferred that they might likewise prove useful in typhus putridus.